Prevalencia de deficiencia de vitamina D y de los factores de riesgo asociados en una cohorte española de adultos infectados por VIH. Efecto del tratamiento antirretroviral

Abstract

The interest for the role of vitamin D in HIV infection comes from its immunomodulatory properties, after the discovery of nuclear vitamin D receptors in various cells, specifically immune system cells such as T and B lymphocytes, monocytes and dendritic cells. Recently, low vitamin D levels have been associated with HIV-AIDS disease progression and its complications. The EuroSIDA cohort, comprising 20,000 subjects, presented data in the Tenth International Congress on Drug Therapy in HIV Infection in 2010, emphasizing the relevance of vitamin D deficiency on global mortality and AIDS-related and non AIDS-related mortality. In recent years, data on severe vitamin D deficiency in HIV-infected patients have been published in different countries. This year, data of the SUN study have been presented. At variance with most previous studies, the sample (n=672) was much greater and this study compared vitamin D insufficiency and deficiency in HIV-infected adults, following present criteria for classification of vitamin D status. Rates of vitamin D deficiency or insufficiency were high, 29.7% and 70.3% respectively, using 20 and 30 mg/mL as cutoff points. In HIV infected patients, hypovitaminosis D is not only related to classic risk factors prevalent in general population, such as malnutrition, exercise, ethnicity/race, advanced age and inadequate sunlight exposure, but also with HIV-linked factors and several antiretroviral drugs. HIV itself can lower 25(OH)D levels through the inhibitory effect of proinflammatory cytokines such as tumor necrosis factor (TNF)-α. Vitamin D is also used in lymphocyte T maturation and proliferation. Protease inhibitors (PIs) block 25(OH)D hydroxylation and 1,25(OH)2D bioactivation. Cross-sectional and longitudinal studies show that efavirenz(EFV)-based HAART is associated with low vitamin D levels. In published papers, Spanish HIV-infected patients are absent. This is the reason of the present work, in which prevalence and vitamin D status of an adult HIV-infected population living in Spain (latitude 40 degrees North) in HAART era is studied, and is compared with results of general Spanish agematched, HIV-free population living in the same geographical area.